NPIMap

Organization Active NPI

Tina S. Patel, O.D. , Professional Corporation

  • Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1073322384
Registry record updated Jan 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
TINA S. PATEL, O.D. , PROFESSIONAL CORPORATION
Practice address
631 N Broadway
Los Angeles, CA 90012-2801
Phone
(213) 680-0404
Fax
(213) 680-2853
NPI assigned
Jan 1, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tina Shantubhai Patel, ODNPI 1174702294
Title
Owner/Optometrist
Phone
(310) 722-7520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

631 N Broadway
Los Angeles, CA 90012-2801

Mailing address

631 N Broadway
Los Angeles, CA 90012-2801
Phone (213) 680-0404

Other names 1

  • LA Vision Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250211001560 CA Part B Supplier - Clinic/Group Practice 6002346707 Receives reassigned benefits from 2 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735689600000",
    "number": "1073322384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900122801",
            "telephone_number": "213-680-0404",
            "fax_number": "213-680-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 N BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900122801",
            "telephone_number": "213-680-0404",
            "fax_number": "213-680-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TINA S. PATEL, O.D. , PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-01",
        "last_updated": "2025-01-01",
        "certification_date": "2025-01-01",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "SHANTUBHAI",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "310-722-7520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LA Vision Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.